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When you register with Disability Action Haringey (DAH), you will provide us with information which we will store confidentially (primarily digitally, but this may include some hard copy files). Your privacy is important to us, and this form asks for your acknowledgement that DAH will gather and store your information securely and in line with the UK law on data protection. Our privacy policy is on our website and is available in hard copy on request.

 

By signing this form, you are consenting to DAH holding your data and contacting you, we may contact you using a variety of the options below

Phone Voicemail Text Message (SMS) Email Post
Female Male Transgender Non-binary Prefer not to say Other
Yes No Prefer not to say
White Asian Mixed Black Other
British European Gypsy/Traveller Irish Other White
Chinese Bangladeshi Indian Pakistani Other Asian
Asian and White Black African and white Black Caribbean and white Other mixed
African Caribbean Other black
Arab Prefer not to say Other
Bisexual Lesbian Gay man Heterosexual/straight Prefer not to say Other
Learning disability (e.g. dyslexia) or cognitive Impairment (e.g. head injury) Longstanding illness/condition (e.g. diabetes, cancer) Mental health condition (e.g. schizophrenia, anxiety) Physical impairment/mobility issues Neuro Diverse No condition/impairment Prefer not to say Other
Yes No Prefer not to say
No religion Christian Buddhist Hindu Jewish Muslim Sikh Prefer not to say Other
Yes No
Yes No
Yes No
Yes No

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Disability Action Haringey,
Winkfield Resource Centre,
33 Winkfield Road,
Wood Green Haringey, N22 5RP
Charity Registration Number 1191762
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